Duloxetine: Indications, Side Effects, Dosage, Interactions and Use During Pregnancy

It is a selective serotonin and norepinephrine reuptake inhibitor, used to treat depression , anxiety disorder, and pain.

Duloxetine affects neurotransmitters , chemicals that nerves in the brain make and release to communicate with each other.

Many experts believe that an imbalance between neurotransmitters is the cause of depression and other psychiatric disorders.

Serotonin and norepinephrine are two neurotransmitters released by nerves in the brain. Duloxetine works by preventing the reuptake of serotonin and epinephrine by the nerves after they have been released. The reduced uptake caused by duloxetine increases the effect of serotonin and norepinephrine in the brain.

The mechanism responsible for its effectiveness in treating pain is not known, but it is also believed to involve its effects on serotonin and norepinephrine in the brain.

Duloxetine was approved by the FDA in August 2004 and is approved to treat the following conditions:

  • Major depressive disorder.
  • Generalized anxiety disorder.
  • Diabetic peripheral neuropathic pain.
  • Fibromyalgia
  • Chronic musculoskeletal pain.

What are its uses?

Duloxetine is used to treat depression, generalized anxiety disorder, pain associated with diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain.

What are the side effects of duloxetine?

The most common side effects of duloxetine are nausea, dry mouth, constipation, diarrhea, fatigue, trouble sleeping, and dizziness. An increase in blood pressure can occur and must be monitored. Seizures from the drug have been reported.

Sexual dysfunction (decreased sex drive, orgasm, and delayed ejaculation) has been associated with duloxetine.

Some patients may experience withdrawal reactions when stopping duloxetine. Withdrawal symptoms include:

  • Dizziness
  • Anxiety.
  • Sickness.
  • Vomiting
  • Nervousness.
  • Diarrhea.
  • Irritability and insomnia.

The dose of duloxetine should be reduced gradually when treatment is stopped to prevent withdrawal symptoms. Antidepressants increase the risk of suicidal thoughts and behavior modification in short-term studies in children and adolescents with depression and other psychiatric disorders.

Anyone considering the use of duloxetine or any other antidepressant-like Deanxit in a child or adolescent must balance this risk with clinical need. Patients starting treatment should be monitored for risk of clinical worsening, abnormal changes in behavior or behavior, and suicidal tendencies.

What is the dosage?

The recommended dose to treat depression is 20 or 30 mg twice a day or 60 mg once a day. Patients can start on 30 mg once a day for a week before the dose progresses to 60 mg a day.

The recommended dose for anxiety disorder, pain associated with diabetic neuropathy, fibromyalgia, or chronic musculoskeletal pain is 60 mg daily. Starting with 30 mg daily for a week before increasing to 60 mg daily can help patients adjust to the medication.

Doses greater than 60 mg a day do not bring additional benefits, or at least there is no evidence of it. However, the maximum dose for depression or anxiety disorder is 120 mg per day.

What drugs interact with duloxetine?

Duloxetine should not be used in combination with a monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl).

Or within 14 days after the MAOI is stopped. Allow at least 5 days after stopping duloxetine before starting an MAOI.

Combinations of SNRIs and MAOIs can lead to serious, sometimes fatal reactions, including very high body temperature, muscle stiffness, rapid fluctuations in heart rate and blood pressure, extreme agitation that progresses to delirium, and coma.

Similar reactions can occur if duloxetine is combined with antipsychotics, tricyclic antidepressants, or other drugs that affect serotonin in the brain. Examples include tryptophan, sumatriptan, (Imitrex), lithium, linezolid (Zyvox, tramadol, Ultram), and St. John’s wort.

The fluoxetine (Prozac, Serafem), paroxetine (Paxil, Paxil CR, Pexeva), fluvoxamine (Luvox) and quinidine increase blood levels of the duloxetine reduce their metabolism in the liver. Such combinations can increase the adverse effects of duloxetine.

The combination of duloxetine with aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), warfarin (Coumadin), or other drugs that are associated with bleeding may increase the risk of bleeding. Duloxetine itself is associated with bleeding.

Duloxetine has an enteric coating that prevents dissolution until it reaches a segment of the gastrointestinal tract that has a pH greater than 5.5. In theory, drugs that increase the pH in the gastrointestinal system (for example, Prilosec) can cause the early release of duloxetine.

Conditions that slow gastric emptying (for example, diabetes) can cause premature breakdown of duloxetine.

However, administration of duloxetine with an antacid or famotidine (Axid) did not significantly affect the absorption of duloxetine. Duloxetine can reduce the breakdown of desipramine (Norpramine), leading to increased blood levels of desipramine and possible side effects.

Is it safe to take duloxetine in pregnancy or while breastfeeding?

Duloxetine is excreted in the milk of lactating women. Because the safety of duloxetine in babies is unknown, breastfeeding is not recommended while taking duloxetine.

What else should I know about duloxetine?

Is a prescription necessary for duloxetine?

Yes, you need a prescription.

What brand names are available for duloxetine?

Cymbalta.

What duloxetine preparations are available?

Delayed-release capsules: 20, 30 and 60 mg

How should duloxetine be kept stored?

The capsules should be stored at room temperature, between 15 ° C and 30 ° C (59 ° F to 86 ° F).